Form Rw-3 Form Montana Annual Mineral Royalty Withholding Tax Reconciliation
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Rev_12-09
2009
Montana Annual Mineral Royalty Withholding Tax Reconciliation
Name___________________________________________________
Address_________________________________________________ _
Due_Date_
February_28,_2010
City_ ___________________________________________________ _
FEIN_
_ _________________________
State_ ___________ Zip_Code________________________________ _
Account_ID_
_ _________________________
1._ Number_of_1099-MISCs_with_Montana_withholding_attached_............................ 1.________________________
2._ Number_of_1099-MISCs_without_Montana_withholding_attached_....................... 2.________________________
3._ Filing_method_for_1099-MISCs_.......................................................................... 3._
_Paper_
_Electronic
4._ Type_of_mineral_royalty_withholding_tax_reconciliation_return_ . ............................ 4._
_Original_
_Amended
If you were not required to withhold Montana mineral royalty tax in 2009, please do not complete lines 5 through 8.
5._ Total_Montana_net_royalty_payments_subject_to_withholding_taxes_.................... 5._ $_ _ ________________ ._ ______
6._ Total_Montana_tax_withheld_per_1099-MISC_...................................................... 6._ $_ _ ________________ ._ ______
7._ Total_Montana_withholding_tax_paid_ . .................................................................. 7._ $_ _ ________________ ._ ______
8._ Difference_(line_6_minus_line_7).......................................................................... 8._ $_ _ ________________ ._ ______
If_you_have_an_overpayment_on_line_8,_please_check_the_appropriate_box._........... 8a._
_Please_send_refund.
_
8b._
_Please_apply_to_a_future_liability.
If_you_have_an_underpayment_on_line_8,_please_send_your_payment_for_additional_tax_due_with_the_attached_voucher.
May_the_DOR_discuss_this_return_with_your_tax_preparer?_
_Yes_
_No
Preparer/Title_ _ ____________________________________________________ Telephone_ _______________________
2009 Annual Reconciliation of Mineral Royalty Withholding Tax (Please make additional copies if necessary.)
Quarterly_
A_
B_
C_
D_
E_
Report_
Date(s)_Paid_to_
Montana_Net_Royalty_
Montana_Tax_Withheld
Montana_Tax_Paid
Difference
Period
MT_DOR_
Payment
2009
(MM/DD/YYYY)
Jan-Mar
Apr-June
July-Sept
Oct-Dec
9._Column_Totals
Please_provide_an_explanation_if_there_is_a_difference_on_line_9,_Column_E_______________________________________
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